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HomeMy Public PortalAbout9148, 9144 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 _1 jgeliy:affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES "BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.Q. BUILDING Policy No. Company FOR APPLICANT TO FILL IN ti ADDRESS f� 52 7 FICertified copy is hereby furnished. BUILDING 9i4 �M 5 79 5 XQ1V� ADDRESS A� LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. k CROSS,ST. Date Applicant NEAREST DISTRICT NO. 1 GROUP TYPE PROCESSED BY CROSS ST. �/I L e- CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL L/o COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This Section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) usE OF slzE of LOT EXISTING BLDG. I certify that in the performance of the work for which this } D_ permit is issued, I shall not employ any person in any manner OWNER . j HAV C44011LL o so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP MAIL ADDRES 2412544RI10/ JY7 p Date -1 Applicant `J TEL ,/f a NOTICE TO APPLICANT: If, after making this Certificate of CITY lino No. 618 -�?1~�J lj OCCUPANT LOAD yy Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and effect. �Gca-G PARKING REQ�D � PROVIDED 1 ••rr SPACES J License Number Lic. Class ON` /l�lG LIMITED TIME USE Contractor Date DATE DATE FROM: TO: El I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI TURF iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL i Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS nn a - ON LOT AND USE 44 License i.iSE i;E-•(^��� � ;r'�a.?.r I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness usi ness and Professions Code): NO. PARKING ElI, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency m-D1ClL for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE �brdinances and State laws relating to building construction, ae-O and hereby authorize representatives of this County to enter TOTAL FEE upon the aboviimentioned property for inspection purl,s t0 SEE REVERSE FOR EXPLANATORY LANGUAGE `� Si o ) ee Date 1 WORKER-S'COh3PENSATION DECLARATION 75M444 MISCELLANEOUS�. APPLICATION "• CE 875 (11-84) I hereby affirm that Ithave a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure or a c2rti:icate of Workers'Compensation Insurance,or a certified'copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS /l.� �! �-• Certified copy is hereby furnished. ADDRES /Ny�g A e. LOCALITY ADDR El Certifiedcopy is filed with the county building inspection LOCALITY NEAREST department. cRoss sT. eL�y�/f Date Applicant NEAREST DISTRICTNQ. GFZOUP TYPE PROCESS BY CROSS ST. /+�d�J n CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �/ �( COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCA NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this D- permit is issued, I shall not employ any person in any manner OWNER ` �r �( N U so as to become subject to the Workers' Compensation Laws. MAIL S OCCUPANCY GROUP �•� a AD DRES �1. l Date Applicant I, NOTICE TO APPLICANT: If, after making this Certificate of CIT No.`T ��3D7�/G gv OCCUPANT LOAD Z Exemption, you should become subject to the Workers' ppLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth with comply with such provisions or this permit shall be TRAILER USE ❑ GE LOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIO Panic Devices 0 I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and effect. � , 5 PARKING SPACES REO'D � PROVIDED License Number Lic. Class `- LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). `) yem_� PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS NO Fa'E ON LOT AND USE I hereby affirm, that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- - k•r ?l , ness and Professions Code): NO. PARKING P- I _000 SPACES PROVIDED ? �. 1 PM, ie�IyF F1 I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency ✓ for the performance. of the work for which this permit is issued(Sec. 3097,Civ.'C.). Lender's Name n I/ PROPOSED MAX. OCC. 1\ Lender's Address / VVV r PERMIT FEE ' I certify that I h e read this application and state that the above informati is correct. I agree to comply with all County ISSUANCE FEE ordinanc/anS e a s relating to building construction,and hereresentatives of this County to enter TOTAL, FEEu on the d roperty for i. s ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r atu 'mit ee Date I \YORKERS'COMPENSATIONDECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION � CE 875 � . 1 hereby affirm shat I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or 1�1 a certified copy thereof(Sec.3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. X BUILDING 9144 E. Las Tunas Dr. LOCALITY ADORE Certified copy is filed with the county building inspection X LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTR T NO. GR����llllllllP JTYPE_,,�:;o� CESSED BY CROSS ST. Loma Ave. D -fi CONST i CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL O COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) USE OF //l� SIZE OF LOT EXISTING BLDG. G(/ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner OWNER Wei—Han Chou, M.D. ® , so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP — % AD0RE55 2403 San Gabriel Blvd. - Date applicant X T NOTICE TO APPLICANT: If, after making this Certificate of CITY Rosemead CA 917,`%b 818-571 -6651 OCCUPANT LOAD - Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: — Compensation provisions of the Labor Code, you must forth- t with comply with such provisions or this permit shall be TRAILER USE I GEOLOGY INSPECTION �` No Spec. Knowl. deemed revoked. — N LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION rX Panic Devices I hereby affirm that [ am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW - 9 (commencine with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and eIfeCY. PARKING REO'D D PROVIDED O SPACES License Number Lie. Class LIMITED TIME USE In Contractor DateDATE DATE FROM: TO: [ am exempt from :he !icensine eauirements as I am a ! licensed architect or a re^__istered professional enainee: 51ZE OF NO. OF INSPECTOR'S' ? acting in Inv professional capaCitr. I.Sectioll "OS i. Bus- EXIST:NGBL�G. (STORIES SIG URE inessandProfessionsCode)- FINAL APPROVAL '-' Lie'.or Ree. No. Date PRESENT USE OF 9UILDING - HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that 1 am exempt from the Contractor'sFE License Law for the followin_ reason !Section 7031.x. BU)i- ISI -} 01 ij ness and Professions Code): v NO. PARKING 6998 1 'M1_ 127'.02, SPACES PROVIDED 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044.Business and Professions Code). CONSTRUCTION LENDING AGENCY X PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agencv Medical/Clinical Laboratory s' for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address 25.00 PERMIT FE_ I certify that I have read this application and state that the above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and herebv authorize representatives of this County to enterTOTAL FEE 25.00 upon the above-mentioned roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SiEnature of n�771irtee Date WORSERS'CObfPENSJ.TION DECLARATION 76M444 A CE 875(11-84) M ISCELLA.N EO U S APPLICATION I hereby affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY,DIVISION insuie, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Ll Policy No. 0 1 oaCompany A1C-0 U6ae4,'(fC& FOR APPLICANT TO FILL IN B;.,iLDING T11`^/� © A,'.OR ESS � �•vl► `tI s. lop— Certified copy is hereby furnished. BUILDING ADDRESS t O LCALITY q AW LY Certified copy is filed with the county building m$peCLlOn LOCALITYN AREST J department. Temple City CzOSS sT. �p DateApplicant NEARESTP IT DISTR DN O�• YN P SSED BY CROSS ST. 1- CONST. 7 I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK .,..> MIGRWAY STATE MAJOR SECOND LOCAL Nei. (CIRCLE) i NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT U,',!Z ZONEISPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) USE of ( SIZE OF LOT I EXISTING BLDG. I I ?• I certify that in the performance of the work .or which this _ permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Latus. MAIL OCCUPANCY GROUP I /rT72 ADDRESS ! Date ?Applicant TEL. NOTICE TO APPLICANT: If, after making this Certificate o: CITY' � L,� C � NO, Z 0 11 OCCUPANT LOAD Exemption, you should become subject to the Workers' - I — Compensation provisions of the Labor Code, You must forth- APPLICATION FOR EXIT HARDWARc: ! with COmDI}' with such DIovisions Or tnls permit shall be TRAILER JSE GEOLOGY INSP=CYTON � o deemed:evoked. — — No Spec. Kno�wi. IJ LICENSED CONTRACTORS DECLARATION i OCCUPANCY INSPEC71CNgg , �an;C Devices n 1 hereby affirm that 1 am licensed under provisions of Chapter ISAF=T. PERMIT (LIST ITEMS BE Lot': 9 rcommzncing with Section '0001 e Division _ Of:he Busi- NO. OF =XITS ; ness and Professions Code. and my license is in full :once and i ( _ efI eCt. I P:i3K:NG PR O:'1D EO I Z II 2 License Number C. Class ! _ LIMITED TIME USE Contractor late ) __ _ I 1 1 ;1.T. e\Cnlpi :rOm the !]C2nSli1g 'eOUll: ?2n. as 1 :lm �-y �•J 11Cen$ed architeci Or a regiStereQ 7r0'ZSSionai Ln_inte I s;Z- OF i;;C, C; j iNSPEC7CR•5 SIGNATURE acring m my proiessionai Capai!- !i)e;tion C_1. DIIS1 XIST;NG BL-,G. CRIES i iness and Proiessiens COLIC). -RESENT uSE OF BUILDING !F;NAL APPROVAL Lic.or Reg. No. Date J l HOME OWNER-BUILDER DECL.yR=TiON NO. OF EXISTINGBUILDINGS O On; LOT :.NO USE D � 1 hereb}• affirm that t am exempt from the Cont- actors License Law for tl�he folloing ieason i Section '031.5. Busi- ness and Professions Code): 'NO. PARKING ❑ SPACES PROVIDED (Z- structure I, as owner Of the property. will do rile work and the structure is not intended or offered for sale (Section t 7044.Business and Professions Code'). CONSTRUCTION LENDING.�IGENC1" PROPOSED -.-F UILDING 1 iierem, affirm that there is a construction lending a2encv ! for the performance of the work for which this permit is issued(Sec. 3097,Civ. C.). Lender's Name t 1nI PROPOSED MAX. OCC. Lender's Address t I certify that I have read this application and state that the PERMIT FEE 25.00 A`d above information is correct- I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, 'tI 1 and hereby authorize representatives of this County to enter TOTAL FEE 25+00 ` I upon the above- 940ned property for inspection purposes. r'rJr) SEE REVERSE FOR EXPLANATORY LANGUAGE Ivy" C✓ l r.: a Sienature of Permittee Date "`